Cystic Acne

Also known as: Cystic acne, Nodulocystic acne, Severe acne, Acne vulgaris (severe), Nodular acne

Cystic acne is the severe end of acne vulgaris, with deep, painful, inflamed nodules and cysts, usually on the face, chest and back, carrying a real risk of permanent scarring and significant impact on self-esteem and mental health [1][2]. It is driven by hormones (androgens), excess sebum, blocked pores, bacteria and inflammation, and it does not respond to over-the-counter products alone. Medical treatment is the standard of care: prescription topicals, oral antibiotics, hormonal therapy for women, and isotretinoin for severe or scarring disease [1][2][3]. Early effective treatment prevents scarring, so delaying medical care to try alternatives alone is a disservice to the patient [1][3]. In Chinese medicine cystic acne corresponds to Lung-Stomach Heat with Blood Heat and Toxin, often with Phlegm-Blood stasis binding into nodules, and in women frequently worsens premenstrually with Liver involvement. Acupuncture and herbal medicine are adjuncts to dermatological care, with some evidence for acne generally but limited evidence for severe cystic disease [4][5].